Provider Demographics
NPI:1225593981
Name:HILL, CARLA RENE
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:RENE
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32041-1206
Mailing Address - Country:US
Mailing Address - Phone:904-548-7099
Mailing Address - Fax:
Practice Address - Street 1:97199 HARBOR CONCOURSE CIR
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3873
Practice Address - Country:US
Practice Address - Phone:904-335-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL18000227748374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide